2012 Potpourri X

An AonHewitt survey looked at employer views on the looming health exchanges.  The survey found that over 90% of employers say that they are committed to continuing to offer employee health benefits, but most are very concerned about costs and view private health exchanges as the best way to help reduce costs.  Almost 90% say cost reduction is the main reason they would use an exchange.  Most employers are examining the use of a defined contribution model in the exchange context as a way of fixing their outlays on health coverage.  While it is unclear to what extent employers will utilize the state exchanges, many are actively considering private, intracompany exchanges.    (Aon Survey)

Research published in the Annals of Emergency Medicine compares emergency room utilization between adults with Medicaid coverage versus those with private insurance.  One assumption is that adults with Medicaid face barriers to primary care access because many doctors don’t accept Medicaid or the patients live in areas with few physicians nearby.  This assumption should be challenged as other research shows that many Medicaid enrollees simply are poor health care consumers and don’t even make the effort to understand where they could get care and simply head to the ER instead.  As might be expected, Medicaid enrollees had significantly higher ER usage than did individuals with private coverage.  The best solution is to incent/penalize Medicaid enrollees for failing to use an appropriate site of care.  Otherwise they won’t change their behavior.   (ER Article)

It gets old to list all the ways the Administration and Democrats in Congress misled to get the health reform act passed and the ways in which it is proving to be more expensive than projected.  The Congressional Budget Office’s new ten year budget projections show the law will both be much more expensive than originally projected, cause more people to lose private coverage and result in fewer people overall having coverage.  The work is part of a larger analysis of federal spending, revenues and deficits which indicates that under the President’s budget deficits and debt rise dramatically, largely due to excessive and unchecked health spending.     (CBO Report)

The Wall Street Journal has articles on the financial struggles of physician practices, particularly in regard to the cost involved in using more health information technology and meeting quality standards in various programs.  The problem is that new costs are incurred to meet regulatory and payer demands, but rarely do increases in reimbursement, if there even are some, make up for the increased costs.  The new demands also often force increased working hours and hiring of more staff.  It is not yet clear from research that better patient care results from all these programs, but physicians are being stressed by the programs and administrative costs are being driven up.   (WSJ Story)

The Congressional Budget Office examined whether forbidding employers to give employees incentives to use TRICARE if they are eligible for it has had any impact on the practice.  The CBO found little impact because as out-of-pocket costs increase for employees, plans like TRICARE look more attractive, even without incentives.  This work has some relevance to the reform law, because consumers behavior when they have options like being subsidized in an exchange or getting better coverage on Medicaid, may affect their behavior in regard to employment-based coverage, potentially increasing costs in government programs.    (CBO Report)

The Agency for Healthcare Research and Quality does a series of wonderful reports on the quality of various kinds of health research.  These reports are important because if the methodological quality is not high, the results of a study aren’t really very informative and can be misleading.  A recent report focused on selective outcome reporting as a source of bias in reviews of comparative effectiveness of treatments.  If researchers don’t report results on all the outcomes they measured, for example, only releasing positive ones, an incomplete picture is given.  This research found a high rate of selective reported outcomes and analysis, and inadequate tools for researchers to know and identify that a trial has such selective reporting.   (AHRQ Report)